Aljuraiban Ghadeer, Chan Queenie, Gibson Rachel, Stamler Jeremiah, Daviglus Martha L, Dyer Alan R, Miura Katsuyuki, Wu Yangfeng, Ueshima Hirotsugu, Zhao Liancheng, Van Horn Linda, Elliott Paul, Oude Griep Linda M
Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
BMJ Nutr Prev Health. 2020 Jul 8;3(2):133-142. doi: 10.1136/bmjnph-2020-000077. eCollection 2020 Dec.
Plant-based diets are associated with a lower risk of cardiovascular diseases; however, little is known how the healthiness of the diet may be associated with blood pressure (BP). We aimed to modify three plant -based diet indices: overall plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI) according to country-specific dietary guidelines to enable use across populations with diverse dietary patterns - and assessed their associations with BP.
We used cross-sectional data including 4,680 men and women ages 40-59y in Japan, China, the United Kingdom, and the United States from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP). During four visits, eight BP measurements, and four 24-h dietary recalls were collected. Multivariable regression coefficients were estimated, pooled, weighted, and adjusted extensively for lifestyle/dietary confounders.
Modified PDI was not associated with BP. Consumption of hPDI higher by 1SD was inversely associated with systolic (-0.82 mm Hg;95% CI:-1.32,-0.49) and diastolic BP (-0.49 mm Hg; 95% CI:-0.91, -0.28). In contrast, consumption of an uPDI was directly associated with systolic (0.77 mm Hg;95% CI:0.30,1.20). Significant associations between hPDI with BP were attenuated with separate adjustment for vegetables and whole grains; associations between uPDI and BP were attenuated after adjustment for refined grains, sugar-sweetened beverages, and meat.
An hPDI is associated with lower BP while a uPDI is adversely related to BP. Plant-based diets rich in vegetables and whole grains and limited in refined grains, sugar-sweetened beverages, and total meat may contribute to these associations. In addition to current guidelines, the nutritional quality of consumed plant foods is as important as limiting animal-based components.
The observational INTERMAP study was registered at www.clinicaltrials.gov as NCT00005271.
植物性饮食与较低的心血管疾病风险相关；然而，对于饮食的健康程度如何与血压（BP）相关联，人们知之甚少。我们旨在根据特定国家的饮食指南修改三种植物性饮食指数：总体植物性饮食指数（PDI）、健康PDI（hPDI）和不健康PDI（uPDI），以便能够在具有不同饮食模式的人群中使用，并评估它们与血压的关联。
我们使用了来自国际宏量/微量营养素与血压研究（INTERMAP）的横断面数据，该数据包括日本、中国、英国和美国4680名年龄在40 - 59岁的男性和女性。在四次访视期间，收集了八次血压测量值和四次24小时饮食回忆。对生活方式/饮食混杂因素进行了广泛的多变量回归系数估计、合并、加权和调整。
修改后的PDI与血压无关。hPDI摄入量每增加1个标准差，与收缩压（-0.82 mmHg；95%置信区间：-1.32，-0.49）和舒张压（-0.49 mmHg；95%置信区间：-0.91，-0.28）呈负相关。相比之下，uPDI的摄入量与收缩压呈正相关（0.77 mmHg；95%置信区间：0.30，1.20）。对蔬菜和全谷物进行单独调整后，hPDI与血压之间的显著关联减弱；对精制谷物、含糖饮料和肉类进行调整后，uPDI与血压之间的关联减弱。
hPDI与较低的血压相关，而uPDI与血压呈负相关。富含蔬菜和全谷物且精制谷物、含糖饮料和肉类含量有限的植物性饮食可能导致了这些关联。除了当前的指南外，所消费植物性食物的营养质量与限制动物性成分同样重要。
观察性INTERMAP研究在www.clinicaltrials.gov上注册，注册号为NCT00005271。
